Allies for RecoveryAllies for RecoveryAllies for RecoveryAllies for Recovery Information and support options for families living with Information and support options for families living with Information and support options for families living with Information and support options for families living with mental illness and alcohol & drug use in Tasmaniamental illness and alcohol & drug use in Tasmaniamental illness and alcohol & drug use in Tasmaniamental illness and alcohol & drug use in Tasmania

Designed by Hannah GrahamDesigned by Hannah GrahamDesigned by Hannah GrahamDesigned by Hannah Graham

School of Sociology & Social Work, University of Tasmania, and the Salvation Army Bridge ProgramSchool of Sociology & Social Work, University of Tasmania, and the Salvation Army Bridge ProgramSchool of Sociology & Social Work, University of Tasmania, and the Salvation Army Bridge ProgramSchool of Sociology & Social Work, University of Tasmania, and the Salvation Army Bridge Program

AllyAllyAllyAlly

Noun: supporter, collaborator, friend, helper, assistant, team member, someone you trust, someone you work with or walk alongside, with the same hopes and goals

RecoveryRecoveryRecoveryRecovery noun: a process of working towards health and wellbeing, improvement, being able, resilience, hope, acceptance of who you are, participation, being in a place of offering something to others

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Families are a very important and valuable part of a person’s support network, especially when

recovering from mental illness or dependency on alcohol or other drugs. You know your loved one

well, you know what works for them. Inevitably, families living with co-occurring mental illness and

substance misuse will go through ups and downs, and have mixed feelings. Some days may be very

frustrating, some will be stressful, many others will be full of love, joy, giving and teamwork.

This resource includes information for you as a person, an individual family member, as well as

information to help you support your loved one in their recovery, with practical tips for those ups

and downs along the way. Every family is unique, so tailor the information in this resource to fit

your circumstances where you are at now. The information and professional services listed in the

following pages are not here to override your lived experiences or personal expertise, we are here

to come alongside you as allies on the road to recovery.

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ContentsContentsContentsContents Page

Preface 4

Understanding Co-Occurring Mental Illness and Substance Misuse 6

Understanding Substance Misuse and Addiction 7

Drugs Q&A and Services Q&A 8-9

The Impact on Children and Youth and Talking about Comorbidity with Kids 10-11

Parents Again: Grandparents Raising Families 13

Supporting Parents with Comorbidity to Stay Connected 14

Men, Depression and Heavy Drinking 15

Coping with Pregnancy and Parenthood 16

Families Need Support Too! Caring for the Caregivers—Services Listings 17-23

The Cost of Caring: A Family Member’s Checklist for Monitoring Your Own Stress 24

Time Out Tips and Self Care Plans for Carers: Managing Stress and Getting Some Rest 25-26

Help Now: Key Contacts in a Time of Need 28

Useful Websites and Online Resources 29

Mental Health First Aid Tips 31

In Case of Emergency: Signs and Symptoms of Drug Overdose 32

Psychosis Explained: Voices, Visions and Minds that Play Tricks with Reality 33

The Impact of Child Abuse on Adult Survivors 34

Falling Through the Gaps? Mental Illness, Drugs and the Criminal Justice System 35

Helping Someone at Risk of Suicide 36

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PrefacePrefacePrefacePreface Building the capacity of families in our community is fundamental to The Salvation Army’s social programs. ‘Allies for

Recovery’ presents options for families and opens up suites of services more readily available than many realise.

The simple African proverb; “It takes a whole village to raise a child” is a guide for us to invest energies into

development of the families around us. It is a clue to understanding the value of life and health in our community.

The inherent strength of the family model can be that which most assists recovery from the negative effects of co-

occuring mental health and substance use. In Tasmania we have opportunities more so than our larger, more

populous mainland centres, to return to the ‘village’ support structures, where community members care for each

other in more ‘family’ based ways. Resources and knowledge are close at hand and are clearly identified in this

information package. It is to be hoped that in growing the understanding shared here, family supports for those

suffering co-occurring illnesses and addictions can reduce the harsher effects and build capacity for recovery.

Grant Herring Manager, Alcohol & Other Drugs and Corrections Stream, Salvation Army, Tasmania

Recently, I have been working with Hannah Graham on a comorbidity project in partnership with the Salvation Army.

As a part of this, we started to look for information for families about mental illness and substance misuse that was

designed specifically for Tasmanians. It seems that many helpful toolkits and booklets have been made in the last few

years by lots of different organisations, but most of them are for other Australian states. In Tasmania, there are good

information resources out there, but they only give information about one organisation or one area (i.e. just mental

health, but not drug and alcohol). This family information pack was designed in response to this gap, not as a

comprehensive guide, but a good starting point. Bear in mind that this is a ‘living document’ that may be changed or

updated in the future, especially as new services start and existing agencies expand or change.

This information pack is designed to be easy to use and relevant to your everyday needs, whatever life stage you find

yourself at. Our hope is that this resource fosters opportunities to connect with professionals and services who can

join you as ‘allies’ for recovery, offering support and encouragement along the way.

Rob White Professor of Criminology, School of Sociology and Social Work, University of Tasmania

Director, Australian Clearinghouse for Youth Studies

4

ContactContactContactContact Hannah Graham

School of Sociology and Social Work, Email: Hannah.Graham@utas.edu.au

University of Tasmania Mail: Private Bag 17, Hobart, TAS, 7001

http://www.utas.edu.au/sociology/CRU/cru.html

Salvation Army Bridge Program

(Statewide Alcohol & Other Drugs Services) Phone: (03) 6278 8140

Email: Grant.Herring@aus.salvationarmy.org

http://www.salvationarmy.org.au/tasmania

The Comorbidity Improved Services Initiative (ISI) is a capacity building project involving the Salvation Army Bridge

Program and, between 2008-2010, consultants from the School of Sociology and Social Work at the University of

Tasmania. The project is funded by the Australian Government Department of Health and Ageing. The focus of the

project is to build capacity and improve the ability of services to support people with co-occurring mental illness and

substance misuse (comorbidity) and their significant others. One of the project activities is to design resources like this.

Sincere thanks

to Rob White, Grant Herring, Sally Upton, Judy Graham, and the frontline staff at the Salvation Army Bridge Program

and Family Pathways services for their input into various aspects of the content and structure of this resource.

Copyright and Disclaimer The materials presented in this document are for the purposes of information only, and the author does not necessarily speak on

behalf of the University of Tasmania or the Salvation Army as an organisational representative. The information is provided solely

on the basis tha t readers will be responsible for making their own assessments of the topics and matters discussed, and are

advised to verify all relevant representations and information. Obtain independent professional advice before making major

decisions or acting on any information contained in this resource. The methodology and level of evidence may vary across

references cited. All information lis ted as from a specific ‘source’ should be taken as a direct quote of that source, unless otherwise

stated (e.g. adapted from…), and the referenced author or service provider retains that intellectual property and copyright. The

information for each service provider has been cited directly from service provider brochures and literature, professiona l contact

directories, or online websites, and they retain the copyright for anything relating to their service. In the case of uncertainty,

contact the service provider directly to cla rify details and obtain more information. No inference should be made from the

inclus ion or omission of services in this directory, it is not intended to be comprehensive. While every effort has been ma de to

ensure that the information is accura te, the author will not accept any liability for any loss or damange which may be incurred by a

person acting in reliance upon the information. © 2011. Families and community services can freely print/ distribute this resource.

What is Comorbidity? How Common is It?

The word ‘comorbidity’ is a clinical term that refers to lots of different co-occurring medical and social problems, but it is

commonly used to describe a person who has co-existing mental illness and drug misuse. Sometimes this is also called

‘dual diagnosis.’ Drug misuse includes legal and illegal substances, and mental illness includes mental health problems

that can range from depression or anxiety through to schizophrenia, bipolar or eating disorders. Yet the way comorbidity

affects each person can be different.

Comorbidity is more common than you might think. Most of the Australian research estimates comorbidity to be

approximately 45-60%, which means around half of the people who have one problem (mental illness or drug use) also

have the other problem at the same time (Australian Bureau of Statistics [ABS], 2008; Andrews et al., 2003).

Of the 16 million Australians aged 16-85 years, almost half (45% or 7.3

million) have had a mental disorder at some point in their lifetime (Australian Bureau of Statistics, 2008). The most common mental illnesses are anxiety (including post-traumatic stress

disorder) and depression; whereas schizophrenia and psychotic illnesses are rare. Of the 183,900 Australians who self

report using illicit drugs daily, almost two thirds (63%) also have a current mental disorder (ABS, 2008).

There are many pathways to recovery; different people find that different things work for them in staying well and

pursuing a meaningful life in the context of family, work and community. Recovery is not a straightforward or linear

process. For many, the journey of recovery will involve some setbacks, which may require psychiatric or medical

intervention for a time until the person is stable again. The first step is for the person with mental illness and substance

misuse to acknowledge and accept that these problems exist and are willing to seek help (both professional and social, by

family and friends) to achieve change and personal growth beyond symptoms and struggles they may live with.

Understanding Co-Occurring Mental

Illness and Substance Misuse

Hope for Recovery

“Recovery involves a process of building or rebuilding what a person has lost or never had due

to his or her condition and its consequences. Recovery is building or rebuilding healthy family,

social and personal relationships. Those in recovery often achieve improvements in the quality

of their life, such as obtaining education, employment and housing. They also increasingly

become involved in constructive roles in the community through helping others, productive arts

and other communications. Recovery is a reality. It can, will and does happen.”

quoted from ‘Guiding Principles and Elements of Recovery-Oriented Systems of Care’ C. Sheedy & M. Whitter (2009: 20-21) 6

Understanding Substance Misuse & Addiction

One in five Australians abuses or becomes addicted to alcohol in their lifetime.

Adolescents and young adults are four times more likely to have abused alcohol in the

last year when compared to older adults. Men are three times as likely as women to

have drinking problems. Source: Robotham, J. (2010) ‘Alcohol abuse bad, and expected to get worse’ The Age 17/8/2010

Types of Drugs

As shown by the quote above, the most commonly used substances are those that are legal, for example, alcohol,

nicotine, caffeine and paracetamol. There are various categories of drugs, and each of them have different effects on a

person—physical and psychological/social—with some effects stronger than others. The main categories of drugs are:

Depressants: alcohol, cannabis, barbiturates, benzodiazepines (tranquillisers), GHB, opiates and opioids (including

heroin, morphine, codeine, methadone, pethidine), some solvents or inhalants (“glue”, “chroming”);

Stimulants: caffeine, nicotine, amphetamines (including speed, crystal meth/ice, dexies), cocaine, ecstasy, mephedrone,

and slimming tablets;

Hallucinogens: datura, ketamine, LSD, magic mushrooms, PCP, and cannabis and ecstasy have some hallucinogenic

qualities in addition to being depressants.

Substance misuse is spread across all levels of society, age groups,

and genders. People use drugs for different reasons. There is no one

cause of drug use. But there are lots of opportunities for recovery.

The ‘Iceberg Model’ of Addiction

The iceberg model of addiction uses the metaphor of an iceberg to explain

what contributes to a person’s choice to use drugs. The addiction is like the

tip of the iceberg, the 10% that can be seen above the surface, but below the

surface there are lots of other issues that might be fuelling the addiction.

These issues will be different for every person, but there are common

examples in the picture. Understanding why your loved one uses drugs (real

causes) is more important than just knowing what drugs they use, and how

often (surface symptoms). Understanding addiction will help you think of

keys and strategies to support their personal process of recovery.

ADDICTION

Poverty

Abuse

Stress Escape

Family Patterns Anger

Rejection & Loneliness

Shame

Trauma

Betrayal

Mistakes and

Regrets Loss

Violence

Biology

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Drugs Q&A Q: Cannabis Can cannabis use affect a

person’s ability to have kids?

What about the effects of

cannabis during pregnancy? Is

breastfeeding a baby safe?

A: Cannabis is the most commonly

used illicit drug amongst women of

reproductive age or by women who

are pregnant, yet heavy use of

cannabis has been linked to

decreased fertility in women and

men (NCPIC, 2010). Smoking

cannabis during pregnancy can

disrupt the supply of oxygen and

nutrients to the unborn child, which

stunt or restrict the growth of the

foetus and can also result in higher

risk of premature birth, stillbirth or

miscarriage.

When a breastfeeding mother uses

cannabis, THC (the psychoactive

ingredient) passes through the

breast milk to the baby. THC stays in

the baby’s body for several weeks,

so no it is not safe to use cannabis

and breastfeed.

Also, cannabis use by the father

during conception or pregnancy has

been associated with risk of Sudden

Infant Death Syndrome.

Source: National Cannabis

Prevention and Information Centre

(NCPIC) www.ncpic.org.au

Ring the Cannabis Information

Helpline: 1800 30 40 50 (2-11pm)

Q: Ice/Crystal Apparently my adult son has

used ‘ice’ before. What is it? How

do people use it? What kind of

effect or damage can it do?

A: ‘Ice’ is the street name for a form of

methamphetamine, sometimes also

called ‘crystal meth’ or ‘glass’. It is

translucent or white to look at, and

may have a slight tinge of blue, pink

or green in some cases. It can be

smoked, swallowed, or snorted, but

the most common way of using it is

injecting it. Ice used to be very rare

in Australia, but has become more

popular in recent years, especially in

the party drug scene. There are

various harmful side effects of ice:

• Brain: The brain goes into ’fight

or flight’ mode. Heavy ice use

can result in brain damage, and

it can cause memory loss.

• Kidneys: higher risk of kidney

stones or infection because

methamphetamines shrink the

blood vessels in various organs.

• Bladder: higher risk of infection.

• Sex: Meth can increase a

person’s libido, increasing the

risk of unsafe sex.

• Decreased appetite, weight loss

• Sleeping problems

Go online to www.meth.org.au

There’s a help section for families

Q: Safe Injecting What exactly is meant by ‘safe

injecting’? My partner is not ready

to stop injecting, but I’m worried

about the risk of getting HIV/AIDS

or hep C—a risk for both of us.

A: ‘Safe injecting’ involves taking

precautions to reduce the risk of

getting or spreading blood-borne

viruses such as HIV/AIDS or hepatitis C.

New clean injecting equipment is

available from a local Needle & Syringe

Provider (NSP). Family Drug Support

give this advice for injecting drug users:

• Never share any injecting

equipment: this includes syringes,

swabs, cotton wool, spoon, and

anti-septic wash.

• Wash the surface or table being

used with diluted bleach.

• Wash your hands with soap before

and after injecting, and before and

after touching anybody else.

• Swab the area of skin with an anti-

septic swab before injecting.

• Apply pressure to the vein

afterwards using a clean cotton

wool ball (not a swab, as the anti-

septic can stop the blood clotting).

Source: Family Drug Support (2002)

Infectious Disease Prevention: Safe

Injecting and Safe Sex Practices

Ring TasCAHRD about where to get

clean gear and for info on hep C and

HIV/AIDS: phone 1800 005 900.

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Services Q&A Q: Mental Health System

How does the mental health system work in

Tasmania? What are the main agencies involved?

Who do I contact to get my family member help?

A: The main agency involved in mental health service

delivery is the Tasmanian Government Department of

Health & Human Services (DHHS) Statewide and

Mental Health Services. There are four service

streams:

1. Mental Health Services

2. Forensic Mental Health Services

3. Alcohol and Drug Services

4. Correctional Health Services

Within the Mental Health Services stream, there are

different types of services:

• Adult Community Mental Health Services

• Inpatient and Extended Treatment Mental Health

Services (including psych wards in hospitals)

• Child and Adolescent Mental Health Services

• Older Persons Mental Health Services

Who you might contact will depend on what type of

professional support a person needs, and how severe

their illness is. The two main gateways that provide

information and make decisions about access are:

• Help Now: The Mental Health Services Helpline

Available free call 24 hrs a day, 7 days a week,

phone 1800 332 388.

• Community or Residential Rehabilitation Options

—The Maximising Recovery Panel: The Panel is

the referral point to access community mental

health services, e.g. Aspire, Richmond Fellowship

etc. Phone (03) 6230 7549 (South) or (03) 6336

2196 (North/North West)

Source: DHHS (2010) www.dhhs.tas.gov.au/mentalhealth

Q: Youth Health Services

I have a 16 yr old son and an 18 yr old daughter and

both of them are involved with drugs. They don’t want

to see our GP. What services are there for youth?

A: There are various free services available to young people

aged 12-24 years in Tasmania. The following list outlines

most of the key service provider options:

• The Link Youth Health Service + Health Hub (Hobart):

phone (03) 6231 2927 or go to www.thelink.org.au

• Pulse Youth Health Centre (Glenorchy):

phone (03) 6233 8900.

• Headspace (Launceston): phone (03) 6335 3100

• Youth Health Team South: phone (03) 6230 7899

• Youth Health Team North: phone (03) 6334 0800

• Youth Health Team North West: phone (03) 6440 7140

• Anglicare Glenorchy Illicit Drugs Service: (03) 6273 5855

• Holyoake (Hobart): phone (03) 6224 1777

• Youth and Family Focus (Devonport): (03) 6423 6635

• Burnie Youth Alcohol & Drug Service: (03) 6423 6635

• Live Free Tassie: phone 1800 033 595

The important thing about these service providers is that

they are non-judgmental and their core business is the

health and wellbeing of the young person. Most of these

services can facilitate access to professionals who may

come to their services on site or through referral, e.g. GP’s,

psychologists, vein care nurses, youth workers.

Source: Department of Health & Human Services (2010)

http://www.dhhs.tas.gov.au/service_information/

young_people/youth_health_services

9

The Impact on Children and Youth Comorbidity will affect different families in different ways, depending on the type (and associated symptoms) of

mental illness and drug(s) of choice. Children of a parent with comorbidity may encounter situations or ongoing

experiences of increased risk, emotional instability or even trauma. In some cases, government child and family

services may be actively involved in their lives and the functioning and decision-making of their family. Children and

youth may need counselling and professional support to address their own grief and loss and emotional issues if they

are placed into out-of-home care. Alternatively, if still living with the parent with comorbidity, they may internalise a

significant amount of pressure to be a carer and take responsibility to make sure the family is ok.

Routine and stability become increasingly vital in circumstances like these. Consistency of rules, boundaries and

discipline/parental practices may need to be discussed across the care-giving team. For example, getting up at the

same time each day and having similar after-school habits are important parts of a stable routine. Recovery from

mental illness is not linear or steady, setbacks and struggles are a part of the journey. Similarly, addiction is a chronic

and relapsing condition, meaning that there may be months and years of staying clean and sober, and there may also

be times when a person returns to their addiction. A part of having realistic expectations is the process of planning

what will happen if the parent is hospitalised for psychiatric treatment or an inpatient of a detoxification/rehabilitation

facility. Children and family members should know what to expect, ahead of time, to prepare for it when it comes up.

An important part of this process is how children are kept informed. For example, if they are regularly told that their

parent has gone to hospital, over time they may come to hate or fear hospitals, so more careful explanation is needed.

“Why is Mum always crying?”“Why is Mum always crying?”“Why is Mum always crying?”“Why is Mum always crying?”

“When will Mum get better?”“When will Mum get better?”“When will Mum get better?”“When will Mum get better?”

“Why did Dad go to hospital? “Why did Dad go to hospital? “Why did Dad go to hospital? “Why did Dad go to hospital?

When can I see him?”When can I see him?”When can I see him?”When can I see him?”

“Will I get what he has got? “Will I get what he has got? “Will I get what he has got? “Will I get what he has got?

Can I catch it?”Can I catch it?”Can I catch it?”Can I catch it?”

“Why did those people come “Why did those people come “Why did those people come “Why did those people come

to our house? I’m scared.”to our house? I’m scared.”to our house? I’m scared.”to our house? I’m scared.”

“Why doesn’t Pa talk much? “Why doesn’t Pa talk much? “Why doesn’t Pa talk much? “Why doesn’t Pa talk much?

He likes my paintings. But He likes my paintings. But He likes my paintings. But He likes my paintings. But

sometimes he doesn’t talk, sometimes he doesn’t talk, sometimes he doesn’t talk, sometimes he doesn’t talk,

and then sometimes he and then sometimes he and then sometimes he and then sometimes he

doesn’t make sense.”doesn’t make sense.”doesn’t make sense.”doesn’t make sense.”

10

Talking about Comorbidity with Kids The New South Wales Department of Community Services (2005: 8-9) offer guidance to family members and workers

on how to explain a parent’s co-occurring mental illness and substance misuse (comorbidity) to kids and young people:

• You may think that talking to children and young people about these issues may confuse or upset them, make them

feel different or turn them against the parent that is unwell. Or you may feel concerned that the parent who has

comorbidity doesn’t want their children to know what’s happening to them. The reality is that the ‘secrecy’ caused

by not talking about a parent’s mental illness or substance misuse can make it worse and result in children or young

people feeling more ashamed or alone. If they see the fallout or struggles of comorbidity firsthand, they need to be

able to talk about it in a safe, loving environment, without shame because it is not their fault it is happening.

• Children and young people will have their own feelings and beliefs about their parent’s mental illness and substance

misuse. They will have their own explanations and questions. Some children and young people may have had bad

experiences of talking with adults, and may be wary, uncertain or frightened. Others may welcome the opportunity

to talk openly. You will need to bear in mind how they feel about talking about their parent with you.

• One of the best things you can do is listen. Give them the opportunity to tell their story in their own words.

Understand that this may take some time. Allow them to express feelings or reactions they have had. Acknowledge

their feelings and beliefs—they are very real for them. Helpful statements might include: “I imagine other kids must

feel like that sometimes too” or “It is ok to feel sad/cross that Mum is not here at Christmas. I miss her too.”

• Some kids may feel sad or depressed, others may feel angry or frustrated, some may blame themselves or feel

guilty while others may even pretend that nothing’s going on or that they don’t care. Ensure that their teacher is a

part of their support network to confidentially and carefully navigate the different emotions a child may have.

• If a child or young person asks questions, be sensitive but honest in your response. Provide details at an age

appropriate level and use language they understand. Check that they have understood what you have told them.

There is a growing amount of children’s books available about specific types of mental illness or substance misuse.

• Some questions can’t be answered straight away. For example, “when is daddy coming home from hospital?” This

can be difficult to predict and it may be helpful to say: “Daddy is in hospital because he is not well. When he feels

better, he will be able to come home. Maybe we can ring him, or write a letter, or visit when he is a bit better.”

Source: Adapted from NSW Department of Community Services (2005: 8-9) 11

Healthy and happy children need to…

• Know someone loves them

• Know that they are important

• Feel safe from danger

• Have choices and information

• Rely on your care and honesty

• Rely on you always to come home

• Know how to trust

• Have special time just with you

• Know that someone is on their side when they feel

alone and abandoned

• Know that they are not being judged

• Know that they can rely on you to encourage them

• Know that someone is listening to them

• Know that you are taking what they say seriously

• Know that someone cares for them and about

what they did today

• Know someone cares about their interests and

hobbies

• Spend time with friends and family

• Speak to someone outside of their family situation

• See and do new things, learn to be brave and try

new things

• Be told the truth about their mum or dad

• Be allowed to make choices about telling their

friends

• Not be allowed to take on too much adult

responsibility

• Be encouraged to play and have fun

Source: Adapted from Shine for Kids (2008) Putting

Your Child First

12

Parents Again: Grandparents Raising Families Grandparents can provide essential support and stability in the lives of children and youth affected by parental

substance misuse, mental illness and other complex needs. Some grandparents find themselves as full-time parents

again, because their adult children are unable to offer the level of parenting needed. The role of carer may be

formalised through law, for example, by family law parenting orders from the Family Court or care and protection

orders from the Children’s Division of the Magistrates Court of Tasmania. However, many cases are informal

arrangements decided by the family. Here are some services that offer information, referral, and professional support.

Legal and Finances—Help with finding out your rights and responsibilities as grandparent carers

Family Law Hotline: 1800 050 321

Legal Aid Commission: 1300 366 611

Tasmanian Government Department of Education Financial Assistance Unit: 1800 005 636

For information about grandparents accessing child support, carer allowance, family tax benefits, child care benefits,

Medicare benefits, or concessions, go online to www.centrelink.gov.au or call one of these government agencies

Family Assistance Office: 13 61 50 Child Support Agency: 13 12 72 Medicare: 13 20 11

Education and Social Services—Key contacts to support you as a grandparent raising grandchildren

Australian Government Child Care Access Hotline: 1800 670 305

Carer Advisory and Counselling Service, Carers Tasmania: 1800 242 636

Commonwealth Carelink Centre: 1800 052 222

Department of Education: 1800 816 057

DHHS Child & Family Services: South: (03) 6230 7650 North: (03) 6336 2376 North West: (03) 6434 6246

Gateway Services: 1800 171 233

Parenting Line, Tasmanian Department of Health & Human Services: 1300 808 178

Service Tasmania: 1300 135 513

Grandparents who are experiencing stress, anxiety or depression can seek help through a local Community Health

Centre, which also provides family, child and youth health services, community nursing, drug & alcohol advice, and

social work services. To find your nearest Community Health Centre, ring the Service Tasmania 1300 number above.

In 2008, the Education Department recorded 494 grandparent families in Tasmania raising

grandchildren from prep to Year 12. Source: McKay (2009) ‘Grandparent “baby sitter” claim’ The Mercury 12 July 2009.

13

Supporting Parents to Stay Connected Parents who are going through residential rehabilitation programmes, detox, in custody, in hospital, or who are

separated and living elsewhere can benefit from keeping in touch with their children’s lives. Where it is safe and

appropriate to do so, there are significant benefits for children to interact with their parent. The method of

communication will depend on the age of the child(ren), what facilities are available, and what is allowed:

• Visits—Visits are a great opportunity for normal, age appropriate opportunities to play and have fun. The child may

be able to take in special items to show the parent, make the parent a present, or bring a book that they want to

read with the parent. Prior to the visit, parents and caregivers can discuss what is going to happen during the visit in

the case of younger children, who are not used to visiting health or institutional settings (“we will go up the lift

along a long corridor, there will be nurses there. Dad might be in his room or in bed, but he will come out to the

lounge area to talk to us” etc.) Unfortunately, visiting areas can be noisy and lack privacy, with other visitors able to

overhear your family’s conversation. Younger children can also be encouraged to ask the parent they are visiting

any questions they might have, rather than feeling that they can’t talk or be themselves.

• Talking and Technology—phone calls and SMS, email, Facebook, social networking or skype are all possibilities.

• Writing—letters, cards for special occasions, or copies of the child’s school reports or newsletters may be helpful.

• Creative Packages—encourage the child to send paintings, drawings, poems, or craftwork. If old enough to write,

the child may be able to write stories or keep a little logbook or journal of their news, which can then be shown or

sent to the parent. You may do a creative exercise with the child and get them to take photos of their favourite

things (pets, their favourite park, grandparents etc.) and email them, or print them out and post them. Current

photos of the child are something thoughtful that a parent can keep, even if they are not well or stable enough to

see the child regularly.

• Special Events to Celebrate the Parent Coming Home—e.g. doing something thoughtful or special as a family.

• Neutral Access Points—in the case of there being matters of custody and access, you can ask a Child & Family

services worker about supported access visits in special neutral places that are intentionally for these purposes.

Every family is different, and what you choose to talk about will depend on the circumstances

involved. Whether separated for a time or for the long term, keeping in regular communication is

important for the recovery and social connectedness of the parent living with mental illness and/or

addiction. Communication will help reduce the child’s anxiety and isolation.

14

Men, Depression and Heavy Drinking More than just a social drinker, grumpy old man, “typical Aussie male” or tired after work

Depression affects both men and women, but there are differences in how men experience it and respond to it.

Beyondblue, the national depression initiative, say that men are more likely than women to recognise physical

symptoms of depression, and talk about feeling angry, rather than feeling low or sad:

Source: Beyondblue (2010) Depression in Men: Fact Sheet 12 available at www.beyondblue.org.au

If you’re worried about someone who shows these signs, talk about it with them and encourage them to get

professional support (a GP, psychologist) and be honest with the person assessing them about what is going on.

What is meant by ‘alcohol dependency’ and ‘binge drinking’?

Regular drinking can lead to a dependency on alcohol. Dependency can be physical or psychological, or both. Alcohol

dependency is a pattern of drinking that is harmful to a person’s health, relationships, and/or work. ’Binge drinking’ is a

term often used to refer to teenagers, but it is also relevant for adults who are heavy drinkers, whether at home or at

the pub. Binge drinking can be defined in two ways: having six or more drinks in a session or drinking large amounts

every now and then and losing control. Binge drinking can happen over a few hours, or repeatedly over days or weeks.

For some people, drinking can become a way of coping, or a way of escaping, and serve as a form of self-medication.

But because alcohol slows down the body’s central nervous system and brain functioning, heavy drinking can have

quite a serious influence on depression over time, making it worse. Heavy drinkers have an increased risk of alcohol-

related injury or disease, and are at more risk of suicide or self harm.

Behaviours Thoughts and Feelings Physical Symptoms

General slowing down or restlessness

Neglecting responsibilities and not look-

ing after themselves

Withdrawing from family and friends

Becoming confused, worried, agitated

Inability to find pleasure in any activity

Finding it difficult to get motivated

Behaving differently from usual

Denying depressive feelings – this can be

used as a defence mechanism

Indecisiveness

Loss of self esteem

Persistent suicidal thoughts

Talking negatively “ I’m a fai lure”, “It’s

my fault”, “Life isn’t worth livin g”

Excessive worrying about finances

Perceived change of status in family

Moodiness or irritability, anger

Sadness, hopelessness, emptiness

Feeling overwhelmed, worthless, guilt

Sleeping more or less than usual

Feeling tired all of the time

Unexplained headaches, backache etc

Digestive upsets, nausea, changes in

bowel habits

Agitation, hand wringing, pacing

Loss or change of appetite

Significant weight loss or weight gain

15

Coping with Pregnancy and Parenthood Having a baby is a major life change. It can be a time of real joy. For some, it can be hard to cope.

Approximately 16% of Australian women experience difficulties with their thoughts and

emotions during or after pregnancy. Being heard and getting support early is important.

Feeling a bit overwhelmed when faced with the prospect of parenthood is normal. However, Beyondblue describe

some of the signs to watch out for if you or your partner are feeling down or too stressed during or after pregnancy:

Source: Beyondblue (2010) Emotional health during pregnancy and early parenthood from www.beyondblue.org.au

If a woman experiences depression during her pregnancy, this is called ‘antenatal depression.’ If it occurs at some point

in the 18 months after the birth of the child, this is called ‘post-natal depression.’

If you or your partner would like more support, there are a number of options: make an appointment with your GP and

talk about what has been going on and your concerns, find your local maternal and/or child health service, or contact

Beyondblue Info Line: phone 1300 22 4636. Mental Health Services Helpline: 1800 332 388 (24hrs)

Post and Ante Natal Depression Association (PANDA) www.panda.org.au

Common Symptoms of Depression Common Thoughts and Statements Feelings

Crying uncontrollably or often feeling teary

Finding that your moods change dramatically

Feeling very irritable or sensitive to noise or touch

Constantly thinking in a negative way

Anxiety or panic attacks, feeling overwhelmed

Low self esteem, feeling that you are inadequate

Withdrawing, not wanting to be with other people

Eating too l ittle or too much

Thoughts of self harm or harm to your baby

“I’m just so worried about everything.”

“I want to cry al l the time…”

“I can’t concentrate, I don’t seem able to do

anything…”

“How can I feel so bad when I’ve got this

beautiful baby?”

“I’m confused and have no energy.”

“I’m tired… so tired, but I can’t sleep.”

“People are only interested in the baby, no

one is interested in how I feel.”

Angry

Stressed

Guilty

Anxious or fearful

Confused

Resentful

Sad

Depressed

Numb or detached

16

Families Need Support Too!

Caring for the Caregivers Everyone who is a recovery ally deserves to be heard,

helped and treated with respect. Each family member

will have a different perspective and personal needs.

Carers need to be cared for too. This list of Tasmanian

services isn’t comprehensive, but it is a good start…

Anglicare Tasmania—phone 1800 243 232

Anglicare Tasmania offers a number of programs in various locations around the state, including:

• Family Mental Health Support Service—a service for families, carers, partners and children of people experiencing

mental illness. This service offers: access to information and resources; links to other support services; assistance to

develop coping skills; communication strategies for parents and partners; support to children of parents with

mental health issues; family or one to one counselling; group work; workshops; community education; and

outreach. For more information, phone (03) 6213 3555 or 1800 243 232.

• Respite Services—a service offering recreational and in-home support for carers of people with a mental illness. To

access the Respite Service you need to be a carer of a person with a mental illness. For more information, phone

(03) 6213 3555 for the South; phone (03) 6330 3020 for the North; and phone (03) 6424 8581 for the North West.

• Family Relationships Counselling—this service is free for people with a Health Care Card or Pension Concession

Card, and means tested costs for others. It is for anyone who is having problems with their relationships with family

members or partners. For more information, phone (03) 6213 3555.

• East Coast Counselling and Family Support Service—this free service provides counselling and support for

individuals of all ages and families, information about other services, and advocacy. Phone (03) 6376 1810.

• Tools for Men—a program for men who are experiencing relationship or parenting difficulties or relationship

breakdown. Tools for Men provides: counselling; workshops about relationships, personal development and family

issues; brochures, newsletters and other information; community education about issues affecting men, including

fathering, relationships and personal matters. This program is free for people with a Health Care Card or Pension

Concession Card, and means tested costs for others. It is for anyone who is having problems with their relationships

with family members or partners. For more information, phone (03) 6213 3555.

Carers Tasmania—phone 1800 242 636

Carers Tasmania offer a range of services and programmes to support family carers, including:

• Counselling

• Carer Advisory Service

• Education and Training

• Carer Support Groups

• Carer Representation

17

Centacare Tasmania — Counselling for Children and Family Support Program

Centacare delivers a broad range of specialised and professional support, counselling, accommodation, emergency

advocacy, education and training services throughout Tasmania. The ‘Counselling for Children’ service provides

individual and family counselling for children who are experiencing difficulties following parental separation or

divorce, and for children who have experienced family violence and other trauma. Group programmes for children

who have experienced family violence are also available, as are family and relationship counselling serivces.

Centacare Hobart: phone (03) 6278 1660

Centacare Launceston: phone (03) 6331 9253

Centacare Burnie: phone (03) 64318555

Family Relationship Advice Line—phone 1800 050 321

The Family Relationship Advice Line is available from 8am to 8pm, Monday to Friday, and 10am to 4pm on

Saturday, except on national public holidays. It is a national telephone service which provides information on family

relationship issues and advice on parenting arrangements after separation. The Family Relationship Advice Line will

be available to provide you with:

• Information about services to help people maintain healthy relationships

• Information about the family law system

• Advice on family separation issues

• Guidance on developing workable parenting arrangements after family separation

• Advice about the impact of conflict on children

• Referral to Family Relationship Centres and other dispute resolution services

• Organisation of telephone dispute resolution for people unable to attend a family dispute resolution service

• Referral to a range of other services to help with family relationship and family separation issues

Gateway Services—phone 1800 171 233

Gateway is a single point of contact (by phone or visit) for people with a disability and for families with children

aged 0 to 18 years seeking support and services in Tasmania. Baptcare and Mission Australia are the two

community services associated with offering Gateway Services in Tasmania. Gateway

provides information, advice, referral and assessment and helps families and

individuals access a service that will meet their needs, including referral into disability

and/or family specific services. Gateway works with families who need help with:

• Parenting concerns and managing children’s behaviour

• Family conflict and breakdown

• Dealing with the impact of mental health issues

• Dealing with the impact of substance abuse

• Isolation and feeling a lack of connection with their community

• Linking to other support services

The Gateway Services phone line is available Monday—Friday, 9am to 5pm.

18

Holyoake — Family Support, Counselling, Education and Alcohol & Drug Services

Holyoake is a Hobart based service supporting families, individuals, and youth, through programmes such as:

• Parent Program—for parents who are concerned about their adolescent’s or young adult’s drug or alcohol misuse

• Young people’s Program—for young people experiencing problems with a family member’s substance misuse.

• Relationships in Focus Program—for individuals affected by someone else’s addictive behaviour.

For more information, contact Holyoake by phoning (03) 6224 1777 or go online to www.holyoake.com.au

Relationships Australia Tasmania — phone 1300 364 277

Relationships Australia Tasmania employs experienced and qualified professional staff to provide counselling to

individuals, couples and families to enhance, maintain or, where necessary, manage changes in their relationships. The

following range of relationship support services are provided:

• Relationship Counselling

• Family Resilience Project

• Family Dispute Resolution

• Relationship Skills Courses

• Break Even Gambling Counselling

• Step-Families Family Integration Service

• Children’s Contact Service

• Parenting Orders Program

• Services for Youth

• Men and Families Program

S.H.E.—Support, Help and Empowerment — phone (03) 6278 9090

S.H.E. offers a free and confidential counselling and support service to women who have experienced abuse in an

intimate relationship. Services offered through S.H.E. include: individual counselling (face-to-face or phone); support

groups; community education; information and referrals; and a place for women to talk about their situation.

19

Salvation Army Tasmania—Statewide Alcohol & Drug Services and Family Support

The Salvation Army in Tasmania offers a range of services to people of different ages with varying service needs.

Services are delivered out of different locations around the state.

• Family Pathways—a service for families, especially those involved with DHHS Child & Family Services. Services and

interventions on offer include parent training, education and support; 123 Magic cognitive behaviour parenting

program; Ditto, a protective behaviours program; Circle of Security, a program on strengthening the process of

attachment; Ages & Stages, understanding child development, what is helpful and what is harmful; Little Seeds,

understanding trauma, attachment and principles of repair; Play Power, understanding the language of play; School

readiness and early intervention programs for children 0-12; and case coordination for families who have a

significant relationship with DHHS, with the capacity to offer advocacy, support, information and referral.

• Family and Community Support Services—a program which supports families and individuals who may be

experiencing difficulties in the following areas: financial, emotional, relationships, parenting, and practical issues

around day-to-day living. A range of free and confidential services including: food assistance; financial assistance;

support, information and referrals; budgeting, counselling and life skills. Phone Clarence (03) 6244 4615; Glenorchy

(03) 6228 6274; Hobart (03) 6231 5440; or New Norfolk (03) 6261 2353.

• The Bridge Program—an alcohol & other drugs rehabilitation program that offers a number of different types of

services, including residential rehabilitation and day programs (counselling, case management, group therapy),

outreach and aftercare in the community, alcohol & other drugs chaplaincy and court & prison chaplaincy, and pre–

and post-release services for offenders transitioning from prison to the community. These services are delivered out

of Bridge Program offices in Hobart, Launceston and Burnie, with rural and regional outreach available as well. The

residential program is 8 weeks long and only offered in Hobart; there is a minimal cost for the program, which

includes materials, meals, and accommodation. The day program there includes two on-site family units where a

parent who has custody of their children may move in and complete the program to address their substance misuse.

The Bridge has a relationship with a local child care centre and primary school, which will benefit families accessing

the unit who need to put their children into care or school during the day for the duration of their treatment. The

Outreach service is able to provide family inclusive practice and work with family members of clients who are

struggling with addiction and/or emotional or mental health concerns. For more information about the Bridge

Program, phone Hobart (03) 6278 8140; Launceston (03) 6331 6760; or Burnie (03) 6431 9124.

• The Positive Lifestyle Program—a life skills program which consists of ten sessions. It is designed to assist

individuals to develop understanding in the following areas: self awareness, anger, stress, loneliness, grief and loss,

creative problem solving, assertiveness, self esteem, and goal setting. Phone Clarence (03) 6244 4615; Glenorchy

(03) 6228 6274; Hobart (03) 6231 5440; or New Norfolk (03) 6261 2353.

20

Sage Hill Family & Friends Tasmania—Aspire—phone (03) 6323 6100 (N) or 6431 3772 (NW)

A service offered in the north and north west of Tasmania by Aspire, providing support, advice, and advocacy to carers

of people with a mental illness. The service aims to promote resilience and coping skills, increase understanding of

mental health issues, improve the health and wellbeing of the carer, reduce stress and boost opportunities for time out

and socialisation. The Sage Hill service also serves to improve awareness of mental illness through general community

education; the service has a range of resources and information that may be of assistance to carers. The northern office

is located in 15 Wellington Street, Launceston, and the north western office is located in Suite 5 of 15 Wilmot St, Burnie.

Taz Kidz Club and Champs Camps—Anglicare Tasmania—phone 1800 243 232

Taz Kidz Club provides support to children aged between 7 and 17 years whose parents have a mental illness. The Clubs

run after school for eight weeks during the school semester and are designed to provide support and education about

mental illness through a variety of creative and artistic projects.

Champs Camps provide support to children aged between 7 and 17 years whose parents have a mental illness. Camps

are held over two nights, five times throughout the year simply to give young people an opportunity to get away, let

loose and have fun in a safe and stimulating environment.

Youth and Family Focus (YAFF) —phone (03) 6423 6635

Youth and Family Focus (YAFF) provide young people and families on the north west coast of Tasmania with access to

the support, encouragement and resources they need to make a positive contribution to their community. This is

achieved through the identification of issues and the development, then implementation, of appropriate tools and

strategies. Youth and Family Focus is located at 81 Oldaker Street, Devonport, and their services include:

• Focus on Integrated Family Support Service

• Youth Focus Accommodation Service and Focus on Transitional Outreach

• Youth Alcohol and Other Drugs Service

• Illicit Drug Diversion Initiative

• Family Drug Support Service—including counselling and support for families of a drug user

• Needle and Syringe Program

21

Supporting the health of culturally and linguistically diverse families

The Migrant Resource Centre—Multicultural Mental Health and Family Wellbeing

The Migrant Resource Centre (MRC) provides relevant services and resources to promote the benefit and wellbeing of

migrants and humanitarian entrants to Tasmania, particularly those who are vulnerable or disadvantaged. They offer

help to migrants and refugees from all countries, including: older people who have language and other difficulties,

young people, families, community groups, and individuals to overcome language and cultural barriers. A number of

services are available, including:

• Information about service providers for health (including alcohol & other drugs rehabilitation and mental health

services), migration, education, housing, legal, financial, employment and welfare matters;

• Advice and support with issues, including support liaison with government departments and other service providers;

• Information sessions, English classes, skills workshops, special aged care and youth programs;

• Torture and trauma counselling

For more information, phone the Southern Tasmanian Migrant Resource Centre on (03) 6221 0999. Migrant Resource

Centres are also located in Launceston, phone (03) 6332 2211, and Devonport (03) 6423 5598.

Supporting Indigenous health and wellbeing in Tasmania

Aboriginal health and support services across Tasmania, for individuals and families

• Aboriginal Health Service Launceston, phone (03) 6331 6966.

• Flinders Island Aboriginal Association Incorporated, phone (03) 6359 3532.

• Mersey Leven Aboriginal Corporation, East Devonport, phone (03) 6427 9037.

• South East Tasmanian Aboriginal Corporation, Cygnet, phone (03) 6295 0004.

• Tasmanian Aboriginal Centre Incorporated, Hobart, phone (03) 6234 8311.

• Tasmanian Aboriginal Health Service Burnie, phone (03) 6431 3289.

22

ARAFMI Tasmania describe themselves in the following way, ’We are a group of people who have a close family

member or friend with a mental illness, who work together as volunteers to support others in a similar situation. This

shared experience and understanding assists us to achieve our mission’ (ARAFMI Tasmania, 2010).

ARAFMI run a website with helpful links and online resources, they also distribute a newsletter for members, run

workshops, and equip families and friends with information and resources. ARAFMI are involved in offering various

types of support groups in different parts of Tasmania, currently including:

• Family Support Group—Hobart

• HOT (Helping Ourselves Together) - Hobart

• Bereaved by Suicide Peer Support Group—Launceston

• Bipolar Support Group—Launceston

• ARAFMI Carer Support Sessions—Launceston

• Thinking Well Support Group—Newstead

• Other regional groups (see their website for details)

You are not alone. Connect with people who have walked the walk.

ARAFMI Tasmania:

Association of

Relatives and Friends of People

with Mental Illness

Website: www.arafmitas.org.au

Southern office: 3 Bowen Road, Moonah, Hobart. Ph (03) 6228 7448.

Northern Office: 34 Howick Street,

Launceston. Ph (03) 6331 4486

23

A Checklist for Monitoring Your Own Stress Levels Tick as many of the following that apply to you:

� Problems getting to sleep or problems staying asleep � Headaches

� Constant fatigue and tiredness � Heartburn

� Poor concentration or forgetfulness � Moodiness

� Feeling fearful, anxious or overwhelmed � Poor appetite

� Frequent urination � Stomach cramps

� Nervous diarrhoea � Skin rashes

� Over-reaction to small things

� Frequent anger or frustration

� Light headedness

� Lowered sexual desire and/or performance

� Muscle tension or pain

� Faintness, dizziness

� Being jumpy or easily startled

� Sweating, shaking or nervousness

� Shortness of breath without exercising

� Reduced work efficiency

Source: This checklist is directly from Taking Care of Yourself and Your Family:

A Resource Book for Good Mental Health (2009) by John Ashfield (pg 169).

The Cost

of Caring: A Family Member’s Checklist for Self

Assessment

It is important that you avoid burnout and being overburdened

with too much responsibility

24

Tips for a Good Night’s Sleep

• Don’t nap during the day. If you do, it is likely to make it more difficult for you to get to sleep at night. Also, don’t

sleep in to make up for a bad night, it just delays the tiredness.

• Early in the evening, take time out to process what has happened during the day and all the things that are on your

mind. Write down a list of the things that you need to remember, so that you don’t have to go over them during the

night or be worried you might forget something. Include problems or issues that have been on your mind. Practice

doing problem-solving, and write an action list of solutions that are realistic and achievable. Once you have done

this, don’t think about these issues any more for the night.

• Only go to bed if you are actually tired. If you can’t sleep after 30 mins, get up and relax in another room for a while.

• Bed is for sleep! Don’t watch TV, play on a games console, or read in bed. These things will stimulate your mind.

Having a hot shower or bath before bed might help you unwind.

• Establish a routine—set an alarm to wake up at approximately the same time each day.

• Consider your diet and lifestyle. Avoid coffee, smoking, limit your alcohol intake, and exercise regularly.

• Talk to your GP or pharmacist about natural vitamins that might help you if sleeping problems persist.

Tips for Managing Stress

The following tips are from ‘The Stress Toolkit’, an excellent resource by Lifeline (2009) www.lifeline.org.au

1. Talk to someone you trust (partner, colleague, friend or helpline): Talking is a great way to let off steam or get some

perspective, and helps release negative or upsetting feelings remaining inside. Having someone to listen to you, or

you to them, reinforces that you are cared for and valued. As humans, it’s important for us to feel connectedness

with others, especially when we feel isolated or alone.

2. Have a health check with your General Practitioner: Knowing that your body is in sync is an important step in

maintaining good health and resilience. Your GP can check your physical health and general wellbeing for any

negative signs that stress may be causing. Seek urgent medical assistance if you are experiencing severe lack of sleep,

loss of interest in activities you once enjoyed, loss of energy, distress or any other negative physical symptoms over a

period of two weeks, and if your ability to function normally has been impacted.

3. Take up regular physical exercise: Evidence suggests that physical exercise will help you feel good about yourself. As

well as helping your body stay healthy, sport will also help your emotional wellbeing, especially if it is a social activity.

4. Try to eat a healthy, well balanced diet: Diet can play a big part in your emotional wellbeing.

5. Find time to do activities you enjoy: for example, spending time with friends and family, participating in sports or

hobbies, writing, listening to music, reading, going out, travelling, cooking, movies, practicing relaxation techniques.

Time Out Tips: Managing Stress and

Getting Some Rest

Being a carer of someone with a mental illness and/

or addiction can come at a cost to your health. Here

are some tips for consideration…

25

Finding Calm Amidst Troubled Waters Supporting a loved one who has an addiction and a

mental illness can be emotionally draining and

stressful. Your needs should be balanced with family

needs; plan to look after yourself using a plan with

goals and strategies.

The importance of a self care plan for carers

Families are an important recovery resource, and often demonstrate amazing resilience given the circumstances. But

families also risk burnout. You can take responsibility for maintaining your own balanced lifestyle; looking after you is in

the best interests of the family. The following activity has been adapted from O’Grady & Skinner (2007) to help families

think about how to take care of your needs. Everyone is different, people manage difficult situations in different ways.

What are some routines and strategies you could use to return to a place of balance and keeping well?

What gives life meaning? What makes you feel alive? What activities have you done in the past that you really enjoyed?

Try and be specific and make concrete goals for yourself—routines and strategies that are achievable.

Self Care Plan for Family Members

Physical health and fitness Emotional health and social life

Financial stability and lifestyle choice Spirituality and beliefs

26

Common Acronyms and

Abbreviations Both the mental health sector and alcohol & other

drugs sector use a lot of acronyms and specific

language, which can be foreign for clients and family

members. The lists below are a helpful start to

understanding the ‘professional shorthand’ and buzz

words that workers sometimes use.

AA Alcoholics Anonymous

ABI Acquired Brain Injury

ADS Alcohol & Drug Service (DHHS)

ATDC Alcohol, Tobacco & other Drugs Council

of Tasmania (Peak body)

ATOD Alcohol, Tobacco & Other Drugs

ATS Amphetamine Type Stimulant

ATSI Aboriginal and Torres Strait Islander

BBV Blood Borne Viruses

CALD Culturally & Linguistically Diverse

CAMHS Child & Adolescent Menta l Health

Services

CBT Cognitive Behavioural Thera py

CMD Court Mandated Diversion

CSO Community Sector Organisation

DBT Dialectical Behaviour Therapy

DD Dual Diagnosis

DEM Department of Emergency Medicine

(Emergency ward in a hospita l)

DHHS Department of Health & Human Services

(State)

DoHA Department of Health & Ageing (Federal)

DPM Department of Psychological Medicine

(Psych ward in a hospital)

DSM-IV Diagnostic and Statis tical Manual of

Mental Disorders (version 4)

DV Domestic Violence

E Ecstasy

EBP Evidence Based Practice

E-CAT Emergency Cris is and T reatment Team

GLTBI Gay, Lesbian, Transgender, Bisexual and

Intersex community

FASD Foetal Alcohol Spectrum Disorder

HBV Hepatitis B Virus

HCV Hepatitis C Virus

IDU Injecting Drug User

IMP Individual Management Plan

IOM Integrated Offender Management Unit,

Tasmania Prison Service

MHCT Mental Health Council of Tasmania (Peak

body)

MHS Mental Health Services

MI Motivational Interviewing

MMT Methadone Maintenance Therapy

MRP Maximising Recovery Panel (DHHS

Mental Health Services)

NA Narcotics Anonymous

NSP Needle and Syringe Programme

OCD Obsessive Compulsive Disorder

OD Overdose

OH&S Occupational Health & Safety

PICU Psychiatric Intensive Ca re Unit

PTSD Post Traumatic Stress Disorder

QI Quality Improvement

REBT Rational Emotive Behaviour Therapy

SASH Suicide and Self Harm OR Salvation

Army Support Housing

SMART Self Management and Recovery Training

SUD Substance Use Disorder

TasCAHRD Tasmanian Council of Aids a nd Hepatitis

Related Diseases

TasCOSS Tasmanian Council of Social Services

(Peak body)

TPS Tasmania Prison Service

27

Help Now: Key Contacts

in a Time of Crisis These contacts are useful to have if your loved

one has a mental health or drug related

emergency and needs professional assistance

quickly, or if you or another family member need

advice or help.

Adults Surviving Child Abuse (ASCA), information, counselling and advocacy: 1300 657 380

Advocacy Tasmania, statewide, mental health and alcohol & other drugs advocacy: 1800 005 131

Alcohol & Other Drug Information Service, statewide: 1800 811 994 (24hrs)

ARAFMI Tasmania, association for relatives and friends of people experiencing mental illness: (03) 6228 7448 (all hours)

Beyond Blue Depression and Anxiety Information Line: 1300 224 636

Cannabis Information and Helpline: 1800 30 40 50 (2-11pm)

Carers Respite Centre, statewide: 1800 059 059

Carers Tasmania Carer Advisory and Counselling Service: 1800 242 636

Child and Family Services, Emergency After Hours Service: 1800 001 219

City Mission Missiondale, Launceston, alcohol and other drugs residential rehabilitation: (03) 6391 8013

Community Connections, Burnie, youth, accommodation and alcohol & other drugs service: (03) 6432 3610

Emergency Accommodation Helpline: 1800 800 588 (24hrs)

Family Violence Crisis Response and Referral Line: 1800 633 937

Gambling Helpline Tasmania: 1800 858 858 (24hrs)

Health Complaints Commission: 1800 001 170

Inpatient Withdrawal Unit, alcohol & drug service detoxification facility: (03) 6230 7970

Kids Helpline, Counselling for Children and Youth: 1800 55 1800

Lifeline, Counselling and Suicide Prevention: 13 11 14 (24hrs)

Legal Aid Commission, Advice Service: 1300 366 611 (9am-5pm)

Mens Line Australia, Counselling and Support: 1300 789 978 (24hrs)

Mental Health Services Helpline, statewide, advice for carers and help for consumers: 1800 332 388 (24hrs)

Relationships Australia: 1800 002 222

Salvation Army Bridge Program, alcohol & drugs services: (03) 6278 8140 (Sth), (03) 6331 6760 (N), (03) 6431 9124 (NW)

Suicide Helpline, statewide: 1300 132 098

Suicide Call Back Service, statewide, counselling and prevention: 1300 659 467

TasCAHRD AIDS and Hepatitis Information and Support: 1800 005 900

The Link Youth Health Service, Hobart: (03) 6231 2927

Women’s Health South, information services and education: 1800 675 028 28

Useful Websites and Online Resources

� � � Advocacy Tasmania www.advocacytasmania.com.au

� Alcoholics Anonymous Australia www.aa.org.au

� Alcohol, Tobacco & other Drugs Council of Tasmania www.atdc.org.au

� � � Anglicare Tasmania www.anglicare-tas.org.au

� � ARAFMI (Assoc. of Relatives and Friends of the Mentally Ill) www.arafmitas.org.au

� Aspire Tasmania www.aspire.org.au/tasmania

� Australian Centre for Posttraumatic Mental Health www.acpmh.unimelb.edu.au

� Beyondblue (National depression initiative) www.beyondblue.org.au

� Carers Tasmania www.carerstas.org

� � Children of Parents with a Mental Illness (COPMI) www.copmi.net.au

� City Mission www.citymission.org.au

� Colony 47 www.colony47.com.au

� Dads in Distress www.dadsindistress.asn.au

� Drug Education Network www.den.org.au

� � Family Drug Support www.fds.org.au

� Guardianship and Administration Board of Tasmania www.guardianship.tas.gov.au

� � � Headspace www.headspace.org.au

� � Holyoake Tasmania (Hobart) www.holyoake.com.au

� Langford Support Services www.langford.org.au

� Mental Health Council of Tasmania www.mhct.org

� Mental Health Tribunal www.mentalhealthtribunal.tas.gov.au

� Mental Health Services (DHHS, Tasmania Government) www.dhhs.tas.gov.au

� Mental Illness Fellowship of Australia www.mifa.org.au

� � National Lesbian, Gay, Bisexual and Transgender Alliance www.lgbthealth.org.au

� � National Organisation for Fetal Alcohol Syndrome www.nofasard.org

� Relationships Australia www.relationships.com.au

� Richmond Fellowship Tasmania www.rftas.org.au

� � Salvation Army Bridge Program www.salvationarmy.com.au

� SANE Australia www.sane.org

� SMART Recovery Australia www.smartrecoveryaustralia.com.au

� � � The Hobart Clinic www.thehobartclinic.com.au

� Young Carers www.youngcarers.net.au

� � Youth & Family Focus (Devonport) www.yaff.com.au

� Mental health

� Families

� Alcohol & Drugs

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“Families can cope and be resilient, but they need support. Families can cope and be resilient, but they need support. Families can cope and be resilient, but they need support. Families can cope and be resilient, but they need support. Not providing this support robs the whole family of what it deserves, and removes a potentially

important aspect of successful therapy. This in turn costs the whole community.

If they are to be effective and provide quality care to affected people and their family, health

professionals must listen to the feedback from the patient’s family members. In the interests of

the wellbeing of the individual patient and their family, failure to communicate with family

members because of confidentiality requirements must be overcome. Health professionals

must include family members as part of any holistic care management plan—many families

provide accommodation, and social and financial support to the patient, and provide ongoing

care when health professionals are absent… The reports, inquiries, committees—although

sometimes productive—must be matched with resources and action. Also, it is time to stop

punishing these people with problems.

Families and carers, and the affected people, all need to Families and carers, and the affected people, all need to Families and carers, and the affected people, all need to Families and carers, and the affected people, all need to have a voice and a say in how services are provided. have a voice and a say in how services are provided. have a voice and a say in how services are provided. have a voice and a say in how services are provided. Without this participation, families will continue to lack confidence in the system. Losing

families’ confidence will have negative consequences for the patient and the whole community.

Alternatively, recognising and supporting the role of families will have positive outcomes

for everyone.

~ Tony Trimingham {parent, author, founder of Family Drug Support}~ Tony Trimingham {parent, author, founder of Family Drug Support}~ Tony Trimingham {parent, author, founder of Family Drug Support}~ Tony Trimingham {parent, author, founder of Family Drug Support} Quoted from ‘Drug Use and Mental Health’ (2008) by S. Allsop (editor)Quoted from ‘Drug Use and Mental Health’ (2008) by S. Allsop (editor)Quoted from ‘Drug Use and Mental Health’ (2008) by S. Allsop (editor)Quoted from ‘Drug Use and Mental Health’ (2008) by S. Allsop (editor)

”

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Mental Health

First Aid Tips Family are often the first on the scene when a

loved one is having a mental health related

emergency. Developing first response skills

will enable you to offer sensitive, practical

help when they need it most.

What is a Panic Attack?

Panic attacks can be a very scary and overwhelming experience that happen at random in response to various situations,

they develop quickly and peak within 10 minutes. A person having a panic attack may feel like they are very sick or going

to die, and it is often triggered by an event or feelings of being out of control. The following symptoms are common:

Palpitations: rapid heart beat, thumping chest pain, tingling

Anxiety: feeling stressed, freaked out, scared, shaky

Nausea: feeling sick, knots in stomach, abdominal pain, dizziness, sweating, chills or hot flushes

I’m Gonna Die!: fear of dying, fear of losing control, being detached and out of it, fear of going crazy

Can’t Breathe!: shortness of breath, hyperventilation (over-breathing), sensations of suffocating or choking

What should I do if I am first on the scene? First aid responses

• Isolate the person to avoid embarrassment or interruptions from onlookers (especially if in a public space like a

shopping centre or café). If they are able to move to a quiet room or alcove area, this should help their focus. Other

people being loud, bossy, derogatory, panicky or overbearing can make the person’s panic worse.

• Lower your voice and give clear simple instructions: Get them to sit down and lean forward, looking at the ground

with a lowered head, to block out surroundings. Ask them what is going on for them, and ask what you can do to

help. Assess whether an ambulance needs to be called. If symptoms are similar to a heart attack, err on the side of

caution.

• Breathing: hyperventilation (overbreathing) commonly leads to panic attacks. Many people get into the habit of

breathing shallowly when panicked, from the upper chest. Help them to slow down their breathing. If they are sitting,

sit next to them or kneel in front of them and practice breathing deep breaths with them. Only touch the person if

they are comfortable with you touching them, don’t invade their personal space. Breathe in while counting to 4

slowly, then breathe out while counting to 4 slowly. They need to breathe deeply from their stomach/gut.

• Reassure the person: use a lowered voice and continually reassure them throughout the panic attack that they’re

doing well and that you are there for them. If they repeat negative beliefs in a panicked way “I’m having a heart

attack” or “I’m going to die”, reassure them that they are not going to die. Treat them with respect and compassion.

• Tell the person not to fight them when they happen: a number of experts have emphasised the need to accept the

panic attacks when they occur and that it may in fact be helpful if the person tries to ride out the attacks to learn that

no harm will come to them. This may sound strange, but fighting them only increases the level of fear and allows

panic to take on tremendous proportions. By going with the panic, the person is reducing its power to terrify them.

• Diet – unstable blood sugar levels can contribute to levels of panic. Encourage the person to eat regularly and avoid

sugary foods and drinks, white flour and junk food. Caffeine, alcohol and smoking all contribute to panic attacks too.

Sources: Adapted from (1) Mental Health First A id ‘Panic Attacks: First Aid Guidelines’ The MHFA Training & Research Program and

Unive rsity of Melbourne, and (2) Teevan, S., & Gorman, J. (2008) ‘How to cope with panic attacks’ Mind: London.

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In Case of Emergency:

Signs & Symptoms of

Drug Overdose Unfortunately, when a person uses substances, legal or

illegal, there is a risk of misusing or wrongly predicting

how much of a drug their body can handle. Developing

your knowledge of the signs and symptoms of

overdose may help to save a loved one’s life if the

unthinkable happens.

Indicators a Person may have Overdosed

If you suspect that a person has overdosed, call an

ambulance (call 000) immediately. The following

indicators are signs or symptoms of overdose:

• Increasing agitation

• Cold and clammy skin

• Pupils of the eye reduce in size to “pinpoints”

• Their mental state deteriorates (they have

hallucinations, or go into a state of panic or deep

depression)

• They experience noticeable changes in their heart

rate (e.g. it is not beating in a regular pattern, is

below 60 beats a minute or above 120 beats a

minute)

• Lowered body temperature

• Slow and noisy breathing

• Muscles twitching or having spasms

• Their skin turns a blue colour

• They get fluid in their lungs

• They are in a very strange state of stupor or

delirium

• They have convulsions

• They lose consciousness or go into a coma

Indicators of Withdrawal from Sedative

Prescription Drugs (Benzodiazepines)

If you suspect that a person is deteriorating into a

state that poses a danger to their health, call an

ambulance (call 000) or get them to medical help

quickly. Benzodiazepines (“benzo’s”) are commonly

prescribed for people with mental health problems,

especially anxiety disorders or sleep problems, or

people who are detoxifying from other drugs. Some

people take benzo’s illegally as well. If a person

decides to suddenly go off them, after a while of being

dependent, this can pose a medical danger to their

health. A GP or psychiatrist should be involved in any

decision making around reducing medication. The

following indicators are signs or symptoms of

withdrawal from this type of sedative prescription

drug:

• Anxiety, panic attacks, depression

• Rapid mood changes

• Diarrhoea, constipation, bloating

• Insomnia and nightmares

• Irritability and restlessness

• Muscle aches

• Poor concentration and memory loss

• Loss of balance and dizziness

• Loss of appetite

• Breathing difficulties

• Hypersensitivity to light

• Sweating and increased body temperature

• Headaches and blurred vision

• Heart palpitations

• Seizures

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Psychosis Explained: Voices, Visions,

and Minds that Play Tricks with Reality The most common time of life for psychosis to emerge is young adulthood, but it can start at any life stage. The causes

of psychosis are not fully understood, and can involve a number of contributing factors.

Recovery is possible and there are various different types of treatment available to help people living with a

psychotic mental illness, for example, schizophrenia, bipolar disorder, psychotic depression, or schizoaffective disorder.

Symptoms vary from person to person, however, there are common signs to look for. The following description of

symptoms is by the Early Prevention and Intervention Centre (EPPIC)

• Confused thinking: Everyday thoughts become confused and don’t join up properly. Sentences are unclear or

don’t make sense. A person may have difficulty concentrating, following a conversation or remembering things.

Thoughts seem to speed up or slow down.

• False beliefs: It is common for a person experiencing a psychotic episode to hold false beliefs, known as delusions.

The person is so convinced that their delusion is real that the most logical argument cannot make them change

their mind. For example, a person may be convinced from observing the way cars are parked outside their house

that they are being watched by the police or intelligence agents.

• Hallucinations: In psychosis, the person sees, hears, feels, smells, or tastes something that is not actually there.

For example, they may hear voices which no one else can hear, or see things which are not actually there. Some

people with psychosis, for example, think that food tastes as though it is poisoned or talk to things that are invisible.

• Changed feelings: How someone feels may change for no apparent reason. Mood swings are common and they

may feel unusually excited or depressed. A person’s emotions may feel dampened, and they may show less

emotion to those around them, coming across really flat or down.

• Changed behaviour: People with psychosis may behave differently from the way they usually do. They may be

extremely active or lethargic and tired. They may laugh inappropriately or become angry and upset without

apparent cause. Often, changes in behaviour are associated with symptoms already described above. Someone who

believes he is Jesus Christ may spend the day preaching in the city streets. A person may stop eating because they

are concerned that food is poisoned, or have trouble sleeping because they are scared.

Source: Early Psychosis Prevention and Intervention Centre (2006, pg 1) What is Psychosis? Fact Sheet 1 33

The Impact of Child Abuse on Adult Survivors One of the most important issues for families is, unfortunately, rarely a topic of conversation. Child abuse can take

various forms, for example, physical, sexual or emotional abuse, neglect, and seeing domestic violence. Australian

research (Lamont, 2010) identifies mental health issues and drug and alcohol use as common problems for adult

survivors of child abuse (although it needs to be emphasised that these things do not cause each other in all cases):

• Links with Mental Health: ‘Persisting mental health problems are a common consequence of child abuse and

neglect in adults. Mental health problems associated with past histories of child abuse and neglect include

personality disorders, post-traumatic stress disorder, dissociative disorders, depression, anxiety disorders, and

psychosis (Alfifi et al., 2009; Chapman et al., 2004; McQueen et al., 2009; Springer et al., 2007)’

• Links with Drugs and Alcohol: ‘Associations have often been made between childhood abuse and neglect and

later substance abuse in adulthood (Simpson & Miller, 2002; Widom et al., 2007) … In the Adverse Childhood

Experiences Study in the United States, adults with four or more adverse experiences in childhood were seven

times more likely to consider themselves an alcoholic, five times more likely to have used illicit drugs, and ten times

more likely to have injected drugs compared to adults with no adverse experiences (Felitti et al., 1998). The higher

rates of substance abuse problems among adult survivors of child abuse and neglect may, in part, be due to victims

using substances to self-medicate trauma symptoms such as anxiety, depression, and intrusive memories caused by

the abusive history (Whiting et al., 2009)’

Source: Lamont, A. (2010) Effects of Child Abuse and Neglect for Adult Survivors National Child Protection Clearinghouse Resource Sheet,

Australian Institute of Family Studies: Melbourne.

What do I do if a loved one tells me they were abused as a child?

Listen! Be compassionate, not judgmental, and don’t jump into asking investigative questions or offering advice. The

decision to talk about abuse is a big one. Be very aware of your reaction to what they are saying, and how you treat

them after they have told you. Adults Surviving Child Abuse (ASCA) add these suggestions:

‘It is hard to watch someone you care about in pain… Carers and supporters can often feel helpless as they watch their

loved ones struggle with issues that they may not understand, however, simply ’being there’ with a survivor as they try

to reconnect with the world makes the journey all the shorter. Partners and friends don’t need to be heroes. It’s a fine

line to walk between offering support, and trying to ’rescue’ someone, but it’s an important one. Survivors need people

who are constant, consistent and trustworthy… It is important that partners and friends develop clear boundaries, and

look after themselves. Caring for a survivor can be an opportunity for warmth, intimacy, and joy.’ (Source: ASCA, 2010)

Adults Surviving Child Abuse: 1300 657 380 www.asca.org.au Lifeline: 13 11 14

A child is abused in

Australia every 9 minutes.

A child abuse report is

made every 2 minutes. Source: ASCA citing statistics by the Australian

Institute of Health & Welfare (2007)

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Falling Through the Gaps? Mental Illness,

Drugs, and the Criminal Justice System Do you have a loved one who has become involved with the criminal justice system? Some people who use drugs and

alcohol commit crime to fund their habit, or they may have committed a crime while intoxicated or under the influence.

Some people with a severe mental illness may commit crime while unwell, for example, smashing windows or knocking

someone over in the midst of a psychotic episode, stalking, or shoplifting while manic. Sometimes a person gets to such

a stage of crisis that they fall through the cracks or gaps between health and community services, and end up in courts

or in prison. In Tasmania, there are some good programs and services that may be able to offer your loved one a

therapeutic response to their complex needs, using a team approach, yet still keeping in mind the safety of everyone.

Court Mandated Diversion Program, Community Corrections and the Magistrates Court of Tasmania

The Court Mandated Diversion Program (CMD) provides magistrates with an option to divert those offenders who are

eligible into treatment for their drug use, either through the bail or sentencing process. The main goal of the CMD

program is to ‘break the drug-crime cycle by involving offenders in treatment and rehabilitation programs. Other goals

of the CMD program are to improve physical and psychological wellbeing, improve offenders’ relationships with family

and friends, improve offenders’ possibility of gaining or retaining employment’ (Dept. of Justice, 2010). For more

information about this special type of court program, contact the Court Diversion Officers in your region:

• Hobart: phone (03) 6216 4429 or email southcdo@justice.tas.gov.au

• Launceston: phone (03) 6336 2576 or email northcdo@justice.tas.gov.au

• Burnie/Devonport: phone (03) 6434 7265 or email northwestcdo@justice.tas.gov.au

The Mental Heal th Diversion Lis t Program, Forensic Mental Health and the Magistrates Court of Tasmania

The Mental Health Diversion List (MHDL) Program enables magistrates to deliver a more therapeutic response to

defendants (people appearing in this criminal court) whose offending behaviour is caused by mental health issues. The

Court has decided to change its way of dealing with people with mental health issues by providing separate lists or

sittings for them with magistrates and teams that focus on treatment and support. A person can refer themselves into

the program or be referred into it by family members, mental health service providers, magistrates, or lawyers. The

MHDL aims ‘to assist people to address mental health needs relating to their breaking of the law; to improve

community safety and reduce re-offending by people on the List; to improve the psychological and general wellbeing of

people on the List; and to reduce the use of criminal justice punishments for health related behaviours’

Contact Forensic Mental Health Court Liaison: Hobart phone (03) 6233 4561 or Launceston phone (03) 6336 2709.

Do you have a loved one in prison who uses drugs or has a mental illness? There are a variety of agencies that offer

services to prisoners and ex-offenders, to find out more about these services go online to the Reintegration Toolkit

at www.re-integrate.net or phone the Tasmania Prison Service, phone (03) 6216 8180.

35

Helping Someone at Risk of Suicide Thinking about suicide is more common than you might imagine. In Australia, more people (around 2,500) die from

suicide than road accidents each year (Mental Illness Fellowship of Australia, 2005). In addition to this, there are a

number of deaths that have contributing factors such as drug and alcohol use and mental illness, where the cause of

death is hard to figure out whether it was intentional or accidental (for example, some cases of drug overdose).

The important thing to realise is that, while a surprising amount of people might think about suicide, there are a lot who

have these thoughts and then go on to live long and fulfilling lives. Also, not everyone who commits suicide has a

mental illness, and not all people who have a mental illness commit suicide. Recovery from being suicidal is quite

possible, especially if professional allies are brought into a person’s support network to offer options and hope.

At Risk Now: Tasmanian Emergency Contact Numbers

Emergency Services 000

Lifeline: 13 11 14 www.lifeline.org.au

Mental Health Helpline 1800 332 388

Mensline Australia 1300 789 978 www.menslineaus.org.au

Samaritans Lifelink 1300 364 566

Suicide Helpline 1300 132 098

Suicide Call Back Service 1300 659 467 www.suicidecallbackservice.org.au

Getting Help Over Time: Local Services that Offer Support Contact one of the services below, depending on where you live and what types of issues/difficulties are relevant:

Choose Life Services (CLS): CLS offers free counselling and support services for people who are suicidal, as well as

offering support and relief to those affected by suicide. Phone 1300 132 098 or www.parakaleo.org.au

Lifeline: Lifeline offer personal crisis counselling (including telephone counselling), victims of crime services, visitation

and social activities, education and community awareness. Phone 13 11 14 or www.lifeline.org.au

Rural Alive and Well (RAW): RAW offer suicide prevention and community wellbeing services to the Central Highlands,

Glamorgan Spring Bay and Southern Midlands Municipalities. Phone (03) 6259 3014 or www.rawtas.com.au

Salvo Hope Line (Suicide Bereavement): Those who are affected by the suicide of a loved one are at risk themselves.

Phone 1300 467 354 or go online to http://suicideprevention.salvos.org.au/

36

Hold on to Hope for RecoveryHold on to Hope for RecoveryHold on to Hope for RecoveryHold on to Hope for Recovery

“The psychologist helped me to understand the difference between being a carer and a mother. Learning

that the carer role is something you pick up when needed and set down when it’s not has helped reduce my

stress… We mustn't underestimate the value of our loving presence in the lives of our dear ones.

Sometimes, the most I can offer is to be the one who keeps the hope alive—that it is possible for them to

have bipolar and at the same time, live a happy, creative, satisfying life; that my son and daughter can still

explore their potential and have a meaningful place in the world through the people they are, the

relationships they have, the work they do, and the love they give.”

MotherMotherMotherMother Quoted in Anglicare Tasmania (2009) Family Stories of Mental Health (pg 20)

Recovery is a process. It is not just defined by the presence or Recovery is a process. It is not just defined by the presence or Recovery is a process. It is not just defined by the presence or Recovery is a process. It is not just defined by the presence or absence of symptoms or treatment, but by quality of life, absence of symptoms or treatment, but by quality of life, absence of symptoms or treatment, but by quality of life, absence of symptoms or treatment, but by quality of life, personal growth, support options, and access to opportunities.personal growth, support options, and access to opportunities.personal growth, support options, and access to opportunities.personal growth, support options, and access to opportunities.

Relapses are setbacks, not disasters or failures.Relapses are setbacks, not disasters or failures.Relapses are setbacks, not disasters or failures.Relapses are setbacks, not disasters or failures.

Hope is an essential ingredient for all recovery journeys. Hope is an essential ingredient for all recovery journeys. Hope is an essential ingredient for all recovery journeys. Hope is an essential ingredient for all recovery journeys. Seeing a different future is the first step to change.Seeing a different future is the first step to change.Seeing a different future is the first step to change.Seeing a different future is the first step to change.

37